Phobias in Children and Adolescents

A phobia is an identifiable and persistent fear that is excessive or unreasonable and is triggered by the presence or anticipation of a specific object or situation. Children and adolescents with one or more phobias consistently experience anxiety when exposed to the specific object or situation. Common phobias include fear of animals, insects, blood, heights, closed spaces, or flying. In children and adolescents, the identified fear must last at least six months to be considered a phobia rather than a transient fear. Types of phobias seen in children and adolescents include the following:

• Specific phobia. Anxiety is associated with a specific object or situation. The phobic object or situation is avoided, anticipated with fear, or endured with extreme anxiety to the extent that it interferes with normal routines and activities.

• Panic disorder. An unpredictable, unexpected period of intense fear or discomfort compounded by shortness of breath, dizziness, lightheadedness, shaking, fear of losing control, and an increased, racing heart beat (called a panic attack). Symptoms can last several hours, but usually peak after 10 minutes.

• Agoraphobia. Agoraphobia is defined as a fear of open spaces, such as being outside or leaving home alone, related to one or more phobias or the fear of having a panic attack. 

• Social anxiety disorder. Fear of one or more social or performance situations in an age appropriate setting with others within the same age group (for example, school play, recital, giving a speech or book report in front of the class).

• Separation anxiety disorder. This is characterized by fear or anxiety of being separated from an attachment figure, which interferes with regular activities. 

• Selective mutism. The inability to speak in specific social situations in a child or adolescent who can and does speak in other situations.

Research suggests that both genetic and environmental factors contribute to the onset of phobias. Specific phobias have been associated with a fearful first encounter with the phobic object or situation. The question still exists, however, whether this conditioning exposure is necessary or if phobias can develop in genetically predisposed individuals.

Anxiety disorders are common in all ages, with 25 percent of children and adolescents experiencing an anxiety disorder during their lifetime.

The following are the most common symptoms that may occur when a child or adolescent is exposed to, or anticipates exposure to, a specific object or situation that produces intense fear or anxiety. However, each adolescent experiences symptoms differently. Symptoms may include:

• Increased heart rate

• Sweating

• Trembling or shaking

• Shortness of breath

• Feeling of choking

• Chest pain or discomfort

• Upset stomach

• Feeling dizzy or faint

• Fear of losing control or going crazy

• Fear of dying

• Numbness

• Chills or hot flashes

In panic attacks, at least four of the above listed symptoms must occur with or without a known and identifiable cause.

The symptoms of a phobia may resemble other medical conditions or psychiatric problems. Always consult your adolescent's doctor for a diagnosis.

A child psychiatrist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety in their child or teen can help by seeking an evaluation and treatment early. Early treatment can prevent future problems.

Panic disorder, however, may be difficult to diagnose in children and adolescents and may require multiple evaluations and tests in a variety of settings.

Specific treatment for phobias will be determined by your adolescent's doctor based on:

• Your adolescent's age, overall health, and medical history

• Extent of your adolescent's symptoms

• Type of phobia

• Your adolescent's tolerance for specific medications or therapies

• Expectations for the course of the condition

• Your opinion or preference

Phobias, like other anxiety disorders, can be effectively treated. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Treatment recommendations may include individual or cognitive behavioral therapy for the adolescent (focused on helping the adolescent learn new ways to control anxiety and panic attacks when or if they do occur), family therapy, and consultation with the adolescent's school. Some adolescents may also benefit from treatment with medication--specifically, medications to stop the occurrence of panic attacks. Parents play a vital supportive role in any treatment process.

Preventive measures to reduce the incidence of phobias in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by children or adolescents with anxiety disorders.